Mental health care: Vulnerable populations still left behind

Mental health care is improving for most Americans, but declining for people with debilitating mental illnesses, according to a report in Health Affairs (Vol. 28, No. 3).

The percentage of people being diagnosed with a mental illness has increased from 8 percent in 1996 to 13 percent in 2006, but that number still falls short of the estimated mental illness prevalence rate of 20 percent of Americans, says report co-author Richard G. Frank, PhD, of Harvard Medical School. Interestingly, that increase in diagnoses has been driven primarily by physicians, including psychiatrists and pediatricians, Frank says, rather than psychologists and social workers.

"It's not like primary care is stealing patients from psychologists," he says. "It's just that the expansion has all come from the primary-care side."

Meanwhile, while more people are being treated for mental illness, those with serious mental illness are getting less care, with 50 percent reporting contact with a mental health professional in 2000 and only 44.6 percent getting care in 2006. This decline was even steeper among seniors with significant mental health problems, 30.4 percent of whom found treatment in 2000, compared with only 20 percent in 2006.

This shift, says Frank, is probably the result of the rise of managed care, which tends to spread the same amount of money over more people. As a result, more people with relatively minor mental illness are being treated, while people who need intensive care are not. The trend is also related to the popularity of medications, rather than behavioral interventions, he says.

"There has been so much emphasis on the pharmacotherapy side, as opposed to the range of treatments the mental health community has to offer, we may have fallen out of balance," says Frank.